duct (NLD) obstruction is a very common congenital (meaningpresent at
birth) disorder being present is about 5% of newborns.
There is a small tube, the nasolacrimal duct, which connects
the eye socket with the nasal cavity. If this tube is blocked, tears
remain on the lower lid, well up, and roll down the cheek. If this situation
persists, recurrent infection may become a problem.
In the vast majority of children the blockage is at the
very end of the duct where is enters into the nose. Here a small, thin
web, which normal dissolves during the last few weeks of pregnancy,
persists preventing drainage from the duct.
There can also be other abnormalities along the course
of the duct, but this is by far the most common setting for NLD obstruction.
This thin web may actually wither away during the first few months after
birth. When this occurs, the tearing immediately stops. Obstructions
in adults have a completely different cause, treatment and prognosis.
Treatment in children is aimed at two fundamental goals.
first goal is to prevent infection during the initial months awaiting
the opening of the duct on its own. Simple antibiotic ointments are
more effective than drops in this setting. By preventing infection,
scar tissue and spread of infection to adjacent tissues are both prevented.
second goal is to open the obstruction and restore flow of tears through
the duct. Firm, but gentle, massage on the duct will increase thepressure
within the duct and may pop the web open. If this maneuver is unsuccessful,
after a period of time, passing a soft probe down the duct and opening
the web is in order. This is usually done under a general anesthetic
as an outpatient. This minor procedure carries a very high success
rate with few complications. On occasion a second probing is indicated.
Rarely, one of the nasal bones has to be gently moved to open the
mouth of the duct.If these routine measures fail, a new duct can be
surgically rebuilt, but gratefully this is a very rare necessity.